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dc.contributor.authorChamptaloup, Sydney Tayloren
dc.date.accessioned2018-01-31T11:41:19Z
dc.date.available2018-01-31T11:41:19Z
dc.date.issued1920en
dc.identifier.urihttp://hdl.handle.net/1842/27776
dc.description.abstracten
dc.description.abstract1. New Zealand suffered from the 1918 Pandemic of Influenza in common with-the rest of the world. The local manifestation consisted of a primary wave in August and September, and a secondary wave of great severity,which,commercing in Auckland about October 26th spread south, covering the whole Dominion in about two weeks.en
dc.description.abstract2. Meterologieal conditions predisposing to an undue prevalence of respiratory catarrhs during the year were an excessive rainfall and prevailing southerly or south -westerly winds.en
dc.description.abstract3. The low crude death rate, the low infantile mortality rate, the absence of overcrowding and the healthy conditions under which most of the people live indicate that epidemic diseases should not obtain as favourable a soil for dissemination as is the case in countries less favourably situated.en
dc.description.abstract4. The New Zealander is less resistant to Respiratory and Catarrhal diseases than the Britisher, and this fact probably accounted for the undue severity of the secondary wave of the pandemic.en
dc.description.abstract5. The primary wave was characterised by a morbidity and case mortality in excess of the average for the years immediately preceding, but it left no impression on the minds of the people.en
dc.description.abstract6. The secondary wave was characterised by excessive morbidity and mortality and affected New Zealand more severely than most other countries, with the exception of South Africa.en
dc.description.abstract7. The incidence and case mortality was excessively heavy on the Native race as compared with Europeans.en
dc.description.abstract8. The influence of age and sex is seen in higher death rates in males than in females and in both sexes between the ages of 20 - 45 years. Similar results have been recorded in all other countries.en
dc.description.abstract9. There is no definite proof that any particular vessel brought the secondary wave to New Zealand, although popular opinion blames the R.M.S. "Niagara ". Influenza was prevalent in a severe form in the Dominion before the arrival of this steamer, and it is probable that the arrival of several overseas ships about this time with returning troops, each added its quota towards the massing infection.en
dc.description.abstract10. The position in Australia is interesting in that a rigid maritime quarantine, Interstate quarantine, and compulsory wearing of masks, and free public vaccination seem to have delayed the advert of the second wave and to have modified the severity of its incidence.en
dc.description.abstract11. The Administrative measures adopted to combat the Epidemic were similar in essential details to those adopted elsewhere. The division of the larger cities into blocks to which one or more medical practitioners were- attached prevented overlapping in medical attention. The bureaux established in the cities assisted the Medical Officers of Health in the medical and lay organisation, and were of great value.en
dc.description.abstract12. Provision should be made for a return of the Epidemic and the organisation set up, with improvements which experience suggested should be kept in touch with, but there is no indication that New Zealand will be visited by such a severe epidemic until the next world pandemic.en
dc.description.abstract13. The prophylactic use of medicated sprays is a measure of doubtful administrative value. A drug which has a selective action on the influenza virus has yet to be found. The public spray probably allays panic, and satisfies the public that something is being done. If used, open well ventilated rooms should be provided, and the spray generated by compressed air. Steam jets should be avoided as they raise the temperature and humidity of the chamber and predispose to chill.en
dc.description.abstractProvision should also be made to "space out" the subjects, both those waiting and those actually in the inhalation chamber, to avoid cross infection as far as possible.en
dc.description.abstract14. Face masks are a useful means of prophylaxis for medical attendants, nurses, and those coming into intimate contact with patients. They should be made of at least four and preferably six layers of fine mesh gauze, such as butter muslin, and of a sufficient size to cover the mouth and nose and mould into the contours of the face. An ample supply should be available, so that each mask is only worn once and then placed in a convenient receptacle ready for sterilisation. The wearing of masks by the public is a matter for personal consideration, and may give confidence to the excessively nervous. It is not a measure which is likely to have any influence in staying the spread of an epidemic.en
dc.description.abstract15. Prophylactic vaccination with mixed catarrhal vaccines)is not a measure which can be offered to the public with any prospect of success, even if sufficient supplies could be procured in time. Vaccination should be attempted in the case of troops, and in institutions or more or less isolated communities, and in these cases is likely to besot.* value. There seems no reason to withhold vaccination in face of an epidemic, although care should be taken to avoid excessive dosage in view of a possible negative phase for several days after the larger second dose.en
dc.description.abstract16. Pathologically the fatal cases could be roughly grouped under two heads, (1) Those in which there was intense toxaemia with marked haemorrhagic oedema of the lungs as chief features, catarrhal pneumonia being present in parts but only demonstrable microscopically, and (2) Those cases in which there was definite pneumonia, either broncho- pneumonic or lobar in type. The haemorrhagic oedema was present in several type II cases, but was a much less marked feature than in type I.en
dc.description.abstract17. A pneumococcus showing certain unusual cultural features and failing to agglutinate with the type sera of the Rockefeller Institute (type IV), was found in considerable numbers in the haemorrhagic oedema fluid, more especially of the earlier cases.en
dc.description.abstract18. Microscopically type I cases were characterised by a general engorgement of the vessels, haemorrhage and oedema into the alveoli. Definite pneumonic consolidation was absent in most parts 108. though prolonged search revealed small areas of catarrhal pneumonia. There was intense bronchitis and frequently tracheitis. The lymph glands showed evidence of intense toxic absorption.en
dc.description.abstractIn the pneumonic type (type II) , all grades of pneumonic consolidation were met with, from small patches of definite broncho -pneumonia to large areas of the lobar type. The cellular reaction in these varied considerably, in some it was intense, in others scanty, the majority of the cells being polymorphonuclear leucocytes. The variety of appearances may depend on the different microorganisms, as in those cases where Staphylococci were found microscopic abscesses were not infrequent. In these pneumonic cases the haemorrhagic oedema appearance was present in parts other than those actually pneumonic.en
dc.description.abstract19. Sputum examinations were not found satisfactory on account of the difficulty of collecting specimen6 during the earlier part of the epidemic wave. The flora during this stage was largely pneumococcal, but towards the close of the - epidemic this microorganism was much less prominent and the Influenza bacillus became increasingly evident.en
dc.description.abstract20. Blood cultures with one exception were sterile and did not indicate that the disease was in the nature of a septicaemia. This seems to have been the general experience, but in isolated instances influenza bacilli were recovered in blood cultures.en
dc.description.abstract21. No particular microorganism seems to have been responsible for the secondary complications (excluding pneumonias). Influenza bacilli were not found except in the respiratory passages and lungs.en
dc.description.abstract22. In 25 fatal cases, influenza bacilli were found in the lungs ,arid bronchi in 20 cases, pneumococci, mostly type IV, in 19 cases, and the Staphylococcus aureus in 17 cases. Streptococci did not play any great part in these cases. The pneumococci were found in profusion in the earlier cases, but less frequently in the later cases. The Influenza bacillus was more prominent and more readily found in the later cases.en
dc.description.abstract23. In a further study of 15 strains of pneumococci, 2 from empyema fluids, 2 from lung punctures in fatal cases not included in the 25 post mortem cases, 1C from post mortem cases and 1 a stock culture, it was found that 10 belonged to group IV Rockefeller classification, 1 to group III, 2 to group II (atypical), 1 to group I. One culture proved to be.a Streptococcus.en
dc.description.abstract24. The Bile Solubility test is useful in differentiating pneumococci from streptococci, but certain strains are only partially soluble. This may be the fault of the culture medium used or of the bile salt, but there was no indication that this was so.en
dc.description.abstract25. Inulin was fermented in Hiss's serum water by all the strains tested. The rate of coagulation of the medium varied with different strains, some being very active and others delayed. It was complete in three days with all the strains tested.en
dc.description.abstract26. Opinion is divided as to whether the Influenza bacillus or an unknown virus is the cause of Epidemic Influenza, though the latter view is the more generally accepted. Definite proof that a filterable virus is the cause is still required.en
dc.publisherThe University of Edinburghen
dc.relation.isreferencedbyAlready catalogueden
dc.subjectAnnexe Thesis Digitisation Project 2017 Block 16en
dc.titleA study of the influenza epidemic in New Zealand 1918: epidemiology.administration, and bacteriology, with a report on the pathology of twenty-five fatal casesen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelen
dc.type.qualificationnameMD Doctor of Medicineen


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